Total Benefit Solutions Inc

U.S. Supreme Court Contraceptive Ruling

June 30, 2014Ed MacConnell

In a 5-4 decision that was described by one of the dissenting Justices as a “decision of startling breadth”, the Supreme Court has ruled in Burwell v. Hobby Lobby Stores, Inc. that closely held for-profit corporations are not compelled to provide contraceptive coverage under the Affordable Care Act’s preventive care mandate if they object to that coverage on religious grounds. The decision is a “win” for Hobby Lobby who had challenged the contraceptive mandate saying it forced them to either violate their faith or pay fines. Click here to download the bulletin

IBC: Important notice about pharmacy changes

June 30, 2014May 4, 2015Ed MacConnell

A number of clients have asked us about network pharmacy changes from IBC because they have been having issues filling prescriptions. We asked for clarification and we were able to find out that the changes only affect members who are on the following: On the Proactive Suite of plans On the Silver Suite of plans On the Bronze Suite of plans. We were directed to this link which was provided to providers. You may also find this link helpful. Simply if you are on one of the plans, or enroll on one, Rite Aid and Walgreens pharmacies are not in the network of participating pharmacies. As always please feel free… Read More

What is Critical Illness Insurance?

June 30, 2014February 8, 2015Ed MacConnell

Why Critical Illness as a “wrap” plan Because: They’re more affordable than you might think. They’re available for employer groups, individuals and seniors. They make selecting a health plan easier. They provide peace of mind against a catastrophic event and large out of pocket expenses. They’re person and portable, it doesn’t matter where you get your health insurance from, having your own critical illness plan makes it better. Many clients have asked how they can supplement their employees coverage when they get enrolled through the affordable care act healthcare.gov marketplace. Employers are permitted to offer wrap plans that consist of “excepted benefits”, meaning they are not regulated by the affordable… Read More

Misleading information being communicated about member cost-sharing with Quest Diagnostics

June 27, 2014June 27, 2014Ed MacConnell

IBC has become aware that potentially misleading information about member cost-sharing (e.g., copayment, coinsurance, deductible) is being distributed on documents that display the Quest Diagnostics name and logo. The information indicates that members can continue using Quest Diagnostics after July 1 without additional member financial impact or cost-sharing. Please be assured that Quest Diagnostics will be an out-of-network provider effective July 1, 2014. For more information click here. Related: Changes to IBC lab network click here

IBC has selected Laboratory Corporation of America® Holdings (LabCorp) as sole national provider of outpatient laboratory services…

June 17, 2014Ed MacConnell

Independence Blue Cross (IBC) has selected Laboratory Corporation of America® Holdings (LabCorp) as sole national provider of outpatient laboratory services. As the July 1, 2014 effective date approaches, we’d like to give you an update on how the change is being implemented. LabCorp continues to open new locations in the area IBC is pleased to share that 29 new LabCorp Patient Service Centers have opened as of June 16. An additional 18 sites are planned to open by June 30, and several more this summer, to provide even more access for IBC membership. You can find a complete list of LabCorp Patient Service Centers by visiting www.LabCorp.com and selecting Find… Read More

Workplace Posters

June 16, 2014May 23, 2014Ed MacConnell

The Department of Labor (DOL) and its reporting agencies require employers to communicate certain information to their employees. In some cases, the DOL mandates notices to be posted in the workplace. Posting requirements vary based on the size of employer. The following information is required to be posted, depending on business and employer size: Job Safety and Health Protection (OSHA) Equal Opportunity Is the Law Fair Labor Standards Act (minimum wage) Employee Right for Workers with Disabilities (special minimum wage) Family and Medical Leave Act Rights Uniformed Service Employment and Reemployment Rights Federal Construction Project Notice Government Contract Notice Employee Polygraph Protection Act Migrant and Seasonal Worker Act Notification… Read More

Health Care Reform Updates: Updated Model COBRA Election Notice

June 10, 2014Ed MacConnell

Updated Model COBRA Election Notice Includes Information Regarding Health Insurance Exchanges Revised Notice Informs Individuals of New Coverage Alternatives A revised Model COBRA Election Notice is now available for group health plans to inform eligible employees and dependents of the right to continuation of coverage under federal law and how to make an election when a qualifying event occurs. The updated model notice includes information regarding coverage alternatives that will be available through the new Health Insurance Exchanges (also known as Marketplaces). COBRA Election Notice Requirement COBRA (the Consolidated Omnibus Budget Reconciliation Act) generally applies to group health plans sponsored by employers with 20 or employees (including both full-… Read More

Clarification on IBC Pharmacy Changes

June 1, 2014June 27, 2014Ed MacConnell

A number of clients have asked about changes to the IBC pharmacy network. Based on these questions we have found out that indeed there are a few. The changes are related specifically to Walgreens and Rite Aid. The changes only affect the following customers: Clients who have chosen one of the Bronze plans Clients who have enrolled on one of the proactive suite of plans. Rite Aid and Walgreens are not in network for these customers. We asked IBC for further clarification and we received this from a previous press release: Starting in 2014, IBC will introduce a new pharmacy network called the FutureScripts Preferred Pharmacy Network. This network is… Read More

Introducing the AFLAC Individual Dental Plans

May 31, 2014Ed MacConnell

Introducing AFLAC Individual Dental Ask us today for more informtion on an AFLAC Individual Dental plan. Just call our office at (215)355-2121 and a dedicated member of our client service team will be happy to answer your questions or send you detailed benefit information.

New Guidance on Cost Sharing Limits under Health Care Reform

May 29, 2014May 23, 2014Ed MacConnell

The three agencies responsible for the implementation of health care reform (Treasury, Health and Human Services, and Labor) released a joint set of Frequently Asked Questions on cost sharing limits. Health care reform places a limit on the dollar amount of out-of-pocket expenses that a participant may be charged in a year. In 2014, that limit is $6,350 for self-only coverage and $12,700 for other coverage. In 2015, the limit increases to $6,600 for self-only coverage and $13,200 for other coverage. The guidance clarifies that if an out-of-network provider charges an amount greater than the amount allowed by the plan (i.e., balance bills the amount above the usual and customary… Read More

What is Hospital Indemnity?

May 27, 2014February 8, 2015Ed MacConnell

Hospital Indemnity Plans as a “wrap” Many clients have asked how they can supplement their employees coverage when they get enrolled through the affordable care act healthcare.gov marketplace. Employers are permitted to offer wrap plans that consist of “excepted benefits”. A group Hospital Indemnity plan can fit the bill and provide a comprehensive financial support plan for a family dealing with a medical crisis. It also allows the employee to make a more prudent health plan selection by giving them coverage for any large deductibles, co-pays or cost sharing scenarios. Hospital Indemnity plans are available to individuals too. Download more information on Shelterpoint’s Hospital Indemnity plan Below is a… Read More

IRS Highlights Stiff Penalty for Reimbursing Individual Premiums

May 25, 2014May 25, 2014Ed MacConnell

From Health Care Reform Digest: Since the IRS and Treasury published Notice 2013-54 in September 2013, pre-tax employer reimbursement of an employee’s individual health insurance premiums has been a hot topic of conversation. Historically, many employers have provided this type of benefit in lieu of offering a group health plan – a strategy that now needs to be reevaluated as a result of regulations implementing the Patient Protection and Affordable Care Act (PPACA). Q1. What are the consequences to the employer if the employer does not establish a health insurance plan for its own employees, but reimburses those employees for premiums they pay for health insurance (either through a qualified health… Read More

SAME SEX MARRIAGE PA COURT DECISION

May 23, 2014May 23, 2014Ed MacConnell

Prepared by Vince Phillips, PAHU Lobbyist May 22, 2014 On May 20, 2014, Federal Judge John Jones III issued a landmark ruling in Whitewood et al vs. Michael Wolf (Commonwealth of PA) that struck down Pennsylvania’s 1996 Marriage Law specifying that a marriage is defined as being between a man and a woman. The ruling also forced PA to recognize same-sex marriages conducted in other states. On May 21, Governor Corbett said that although as a Catholic, he disagreed with the ruling, he would not appeal it. The ruling is effective immediately but an unanswered question is effective date for employer-offered health plans. Is it now? Is it a month… Read More

Introducing Worksite Benefits

May 20, 2014May 20, 2014Ed MacConnell

INTRODUCING WORKSITE… From Your Trusted Advisor. Worksite Programs are more than just a source of additional insurance products to be purchased at employee expense! A coordinated program will help you manage all your benefits so you can spend more time on your business. Our focus on quality ensures that your employees have the access and affordability that they need. Benefit communication and counseling services help your employees understand and appreciate their benefits. Worksite programs can be expanded and adjusted as your core benefits change, reducing headaches at annual open enrollment time. We have joined forces with the strongest, most reliable Voluntary Benefit providers to offer our clients valuable employee benefit… Read More

Comparative Effectiveness Fee Reminder

May 20, 2014May 20, 2014Ed MacConnell

The Comparative Effectiveness Research Fee is now known as the Patient-Centered Outcomes Research Institute (PCORI) Fee. The Patient Protection and Affordable Care Act (the Act) imposes a new Patient-Centered Outcomes Research Institute (PCORI) fee, formerly the comparative effectiveness research fee, on plan sponsors and issuers of individual and group policies. The first year of the fee is $1 per covered life per year, the second year the fee adjusts to $2 per covered life and then it’s indexed to national health expenditures thereafter until it ends in 2019. Click here to download this bulleting regarding the timely payment of the fees. Purpose of the Fee The assessed fees are to… Read More

19th Set of FAQ’s Released on Affordable Care Act

May 20, 2014Ed MacConnell

Frequently asked questions (“FAQs”), prepared jointly by the Departments of Labor (“DOL”), Health and Human Services (“HHS”), and the Treasury (collectively, the “Departments”),were issued with respect to various Affordable Care Act (“ACA”) requirements, including their effect on COBRA and CHIPRA notices…Topics Include: Updated COBRA And CHIPRA Notices Out-Of-Pocket Maximum Requirements Generic Drugs Balance Billing Reference-Based Pricing Coverage Of Preventive Services Health FSA Carryover And Excepted Benefits Effect of Carryover on Excepted Benefits Determination Summary Of Benefits And Coverage Click here to download the bulletin from our partners at Emerson Reid.

Nuts and Bolts of the Small Employer Tax Credit

May 20, 2014Ed MacConnell

This presentation is intended to convey general information about the employer health care tax credit under the affordable care act and is not an exhaustive analysis. Information contained in this presentation may change as guidance develops. Total Benefit Solutions inc and Emerson Reid do not provide legal or tax advice. For advice specific to your situation, please consult an attorney or other professional. Click here to download “nuts and bolts” Download Small Business Health Care Tax Credit FAQ’sFAQs

Informal Guidance Clarifies Rules HSA Eligibility and Health FSA Carryovers

May 17, 2014May 16, 2014Ed MacConnell

Near the end of 2013, the IRS issued Notice 2013-47 that permits a cafeteria plan to provide for the use of up to $500 of any unused amount remaining in the health FSA in the immediately following plan year (the “carryover” provision). This provision is optional, requires a plan amendment, and cannot be offered if the cafeteria plan allows a grace period. One of the outstanding questions around the carryover provision is the effect it has on HSA eligibility. Recently, the Office of Chief Counsel for the Internal Revenue Service issued a memorandum that informally addresses the interaction of the carryover on HSA eligibility and provides some solutions that may allow an individual retain… Read More

Calculator May Help Small Businesses Determine SHOP Eligibility

May 15, 2014Ed MacConnell

Calculator May Help Small Businesses Determine SHOP Eligibility The U.S. Department of Health & Human Services has developed a Full-Time Equivalent (FTE) Employee Calculator to help small employers determine whether they qualify for the Small Business Health Options Program (SHOP). Background SHOP is available as an option for qualified small employers to purchase employee health coverage. The federal government is running the program in states that chose not to operate their own SHOP Marketplace (Exchange). For 2014, employers are generally eligible to purchase health coverage through the federally-facilitated SHOP Marketplace if they have 50 or fewer full-time equivalent employees (FTEs), including part-time employees. (For example, 2 part-time employees… Read More

Aetna: Important updates to our Pennsylvania Small Group eligibility guidelines

May 1, 2014Ed MacConnell

This briefing is applicable to all brokers writing Pennsylvania based employers We have updated our eligibility guidelines as it relates to sole proprietors, owners, partners, W-2 employees and husband / wife groups for 2014. These updates have been made to maintain compliance with state and federal requirements. Please review the updates we have outlined below. We thank you for your continued collaboration. The following applies to Small Group Pennsylvania new business and renewals: The definition of an employer is now one W-2 common law employee. This accommodates an owner with at least one “enrolling” W-2 common law employee who is not a spouse and not an owner. Sole proprietors, owners… Read More

IBC: Individual Dental and Vision PPO’s Now Available!

April 29, 2014April 29, 2014Ed MacConnell

Please be advised that Independence Blue Cross (IBC) is offering a new portfolio of Dental and Vision Care plans for adults (aged 19 and older) featuring low out-of-pocket costs and access to a large network of providers. These plans will be available for sale online, by phone, and by mail beginning on April 30, 2014, for June 1 effective dates. Offering individual customers Specialty Services products like Adult Dental and Vision Care emphasizes customer choice and helps give members the protection they need by protecting one of their most valuable assets — wellness. 15% discount on Bundled Dental and Vision IBC offers two Dental PPO plans and two Vision Care… Read More

IRS: HSA Contributions and limits for 2015 Released

April 24, 2014April 24, 2014Ed MacConnell

The IRS has released the 2015 cost-of-living adjustments affecting HSAs and HDHPs. The 2015 IRS HSA limits are increasing for 2015. Click to download the bulletin

IBC: Special Care program ending

April 24, 2014Ed MacConnell

As you may already know, the Independence Blue Cross Special Care SM* health care plan will terminate on June 30, 2014. Because the Special Care plan is ending, the individuals who are currently enrolled in this plan will be eligible for a special enrollment period to sign up for a plan that is compliant with the Affordable Care Act (ACA). Special Care members qualify for a special enrollment period All Special Care members will be eligible for a special enrollment period , which will allow them to enroll in an individual or family health plan. Members will have from May 1 to August 29, 2014 to enroll in a health plan… Read More

Healthcare.gov Users Prompted To Change Passwords Because Of Heartbleed Risk.

April 21, 2014Ed MacConnell

The CBS Evening News (4/20, story 8, 1:55, Glor) reported Sunday night that “visitors to the to Affordable Care website are being advised to take steps to protect themselves” from Heartbleed, the online security flaw. Mark Albert reported over the weekend, healthcare.gov made the move to “reset everyone’s account password.” Saturday evening, the NBC Nightly News (4/19, story 7, 0:25, Holt) reported that people “with accounts on healthcare.gov are being told to change their passwords after review found that the website was vulnerable to the security breach bug.” The Hill (4/19, Wilson) “Hillicon Valley” blog reported that the call to change log in information for the site were “out of… Read More

Health Reform: Find out if You Qualify for a Health Insurance Coverage Exemption

April 18, 2014April 17, 2014Ed MacConnell

The Affordable Care Act calls for individuals to have qualifying health insurance coverage for each month of the year, have an exemption, or make a shared responsibility payment when filing his or her federal income tax return. You may be exempt from the requirement to maintain qualifying health insurance coverage, called minimum essential coverage, and may not have to make a shared responsibility payment when you file your next federal income tax return. You may be exempt if you: Have no affordable coverage options because the minimum amount you must pay for the annual premiums is more than eight percent of your household income, Have a gap in coverage… Read More

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